Oregon is using visiting nurses to help curb infant and new mother mortality rates; visits may have other benefits

Why babies do what they do is often a mystery.
(Photo by Chris Anderson, Unsplash)

Some of the most complicated human beings to deal with are the tiniest: babies. Often referred to as "bundles of joy" or "little miracles," babies can be cranky, impossible to calm and impervious to sleep.

With that backdrop, it's fair to say new parents have it tough, and many lack the resources they need to confidently care for a newborn, which can lead to stress, emergency department visits, and even neglect or abuse. To address these needs and provide a response to high infant and mother fatality rates, the state of Oregon implemented an evidence-based program called "Family Connects" that makes life with a newborn better for everyone, reports Cory Turner of NPR. "The program offers any family with a new baby up to three no-cost visits at home with a trained nurse."

After the birth of their first child, Matt and Amber Luman from rural Jefferson County, Oregon, chose to participate in Family Connects. Turner writes, "Matt and Amber seem genuinely relieved when [Nurse] Ibrahim arrives for her second home visit with them." After baby Esserley gets a thorough medical check, "comes the beating heart of any Family Connects visit: the chance for new parents to ask a registered nurse whatever they want. . . . Some share their confusion or frustration. Others are eager for advice or comfort in those early weeks of a baby’s life when new parents are most likely to feel exhausted and adrift."

Most new parents need all the help they
can get. (Photo by T. Heftiba, Unsplash)

The Oregon Health Authority based the state's program on a small, successful Family Connects model developed in Durham, N.C. "Research from its smaller rollout there found it was associated with a handful of significant benefits, including a big drop in the number of trips new parents were making to the emergency room," Turner reports. "A study of Family Connects in Durham found mothers in the program were 30% less likely to experience possible postpartum depression or anxiety."

Oregon policymakers used the Durham program model and expanded it to a statewide outreach. "Every nurse acts as a kind of human clearinghouse of local and regional support for caregivers," Turner explains. "If a family is struggling with housing or food insecurity or addiction, the nurse will connect them with local groups and agencies that can help. Mental health counseling, marriage counseling, child care while mom or dad finishes their degree online."

In Durham's smaller rollout, the program "suggested a real return on investment," Turner reports. "Rolling out Family Connects in Oregon has been a costly struggle." From the pandemic to the nursing shortage to trying to cover a state that can be widely rural, Oregon's program has been expensive. It remains to be seen if the "benefits of Family Connects will outweigh the costs."

Rural trauma deaths would decline if ambulances could bill insurance companies for delivering blood on way to hospital

A fire-district ambulance on a dirt road after a training exercise near Fruita, Colo., last April. The West and parts of the South pose big challenges for rural emergency medical services. (Photo by Smiley Pool, Dallas Morning News)

In 2020, a traumatic injury killed an American every 31½ minutes, and such injuries are the top killer of children and adults under 45. Those statistics could be better if more ambulances carried blood and could bill insurance companies for administrering it, Lauren Caruba of the Dallas Morning News reports in a package with the San Antonio Express-News focused on rural America.

The problem is worst in the sparsely populated West, but "parts of the South performed worse compared with the coasts," Caruba reports. The package focuses on western Colorado and has an interactive map showing how far every location in the 48 contiguous states is from a trauma center.

"The vast majority of emergency medical providers . . . are unequipped and underfunded, leaving them unprepared to fully treat patients with severe internal bleeding," Caruba writes. "Across the country, bleeding patients receive drastically different care depending on where they are injured and the emergency providers who treat them." Awareness of the issue "has been mostly confined to medical journals and discussions within the medical community, leaving the general public largely uninformed about the extent of the epidemic."

"The solution is straightforward: If paramedics widely carried blood, as military medics have done for years, tens of thousands of lives could be spared annually. But the country’s fragmented health-care system does not allow for an easy fix. . . . Despite repeated pleas from specialists, the federal government has not prioritized or properly invested in the plight of injured Americans."

With each minute that passes after a potentially fatal injury, the possibility of death increases, "especially within the first half-hour, when severe bleeding deaths peak," Caruba notes, citing research. "An estimated quarter of all Americans live further than a 30-minute drive from Level I or II trauma centers, which provide the highest level of care to injured patients."

The Defense Department has greatly improved combat death rates with faster evacuation, "increased tourniquet use and administered blood on the way to the hospital," Caruba notes. "No such overhaul has happened in U.S. health care, and efforts have not been made to broadly adopt the military’s best practices, particularly before patients reach a hospital."

In 2019, fewer that 1% of trauma patients "received blood products of any kind on the way to the hospital, even when they displayed clear warning signs of bleeding out," Caruba reports, citing research by the University of Alabama-Birmingham. She notes that there is relatively little research into trauma deaths, and that the federal government doesn't even track them. But a federal report in 2016 estimated that 20,000 to 30,000 trauma deaths a year were potentially avoidable.

The U.S. has more than 23,000 emergency medical services, but only about 100 ground services have blood, "trauma advocates have found in recent surveys. While most air ambulance companies carry blood products, they treat only a small fraction of injured patients," Caruba reports. "Blood is a costly, limited resource, and most emergency medical providers lack relationships with blood banks. They also face regulatory and logistical hurdles, like maintaining blood refrigeration temperatures in the field and creating a system where unused units do not go to waste."

The Prehospital Blood Transfusion Initiative Coalition is focusing on the servcies' "inability to bill insurers for the cost of the blood and the rules in some states that prevent paramedics from starting transfusions," Caruba reports. "The group hopes to present recommendations to Congress and the National Association of State EMS Officials next year. Their goal is that every patient with major bleeding — including the injured and those hemorrhaging from medical complications — will receive blood if they need it."

'Too many babies are dying in the United States'; infant mortality rates rise for the first time in 20 years

The U.S. infant mortality rate is twice that of other
developed countries. (Photo by Jill Sauve, Unsplash)

Over the past two decades, American medicine has made dramatic advances in cardiac care, obesity medicines and organ transplant success rates, but in a sad marker, "the death rate for babies rose for the first time in 20 years," reports Liz Essley Whyte of The Wall Street Journal. According to the Centers for Disease Control and Prevention, "The rate of babies dying in the U.S. increased 3% from 2021 to 2022. . . . The rate increased from 5.44 infant deaths for every 1,000 births to 5.6 in 2022, a statistically significant uptick."

U.S. infant mortality rate is strikingly high at "double that of many developed countries," Whyte notes. "Globally, baby death rates have fallen for decades, though five countries that have reported their rates this year recorded increases for last year. . . . The death rate for women who give birth has also been rising in the U.S. Researchers who study the issues said the pair of trends indicate more women giving birth are facing challenges getting proper care."

Arjumand Siddiqi, a University of Toronto professor who studies population health, told Whyte, "The U.S. is falling behind on a basic indicator of how well societies treat people. In a country as well-resourced as the U.S., with as much medical technology and so on, we shouldn't have babies dying in the first year of life. That should be super rare, and it's not."

American medicine needs to do the basics
better. (Photo by Filip Mroz, Unspash)

The maternal-infant relationship has complex layers, but it begins with how healthy the mother is. "Complications during pregnancy was one of the fastest-rising causes of infant death, the CDC said, along with dangerous bacterial infections called sepsis," Whyte explains. Researchers cited premature births as one likely contributor to the increase, along with poor nutrition throughout pregnancy.

The CDC reports infant-mortality rates every three months. "Its latest report compared birth and death certificate data from 2021 to provisional data from 2022," Whyte adds. "The report didn't give reasons why the rate was increasing, and researchers said they would have to do more studies to determine the root causes." Dr. Elizabeth Cherot, chief executive of the infant and maternal health nonprofit March of Dimes, told Whyte: "We, as a developed country, should be doing some of the basics better. Too many babies are dying in the United States."